Cognitive Impairment in Patients With Traumatic Brain Injury and Obstructive Sleep Apnea

Wilde, Mark C.; Castriotta, Richard J.; Lai, Jenny M.; Atanasov, Strahil; Masel, Brent E.; Kuna, Samuel T.

doi:10.1016/j.apmr.2007.07.012

Cited by 118 publications

(68 citation statements)

References 22 publications

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“…Studies have reported OSA in 35-61% of patients with TBI [44,76]. In addition, patients with TBI with comorbid OSA experience greater neurocognitive impairments in memory and attention than those with similar TBI severity who do not have OSA [91]. Treatment is analogous to those with other causes of sleep-disordered breathing, where positive airway pressure (PAP) is the standard of care.…”

Section: Hypersomnolencementioning

confidence: 99%

Sleep, Sleep Disorders, and Mild Traumatic Brain Injury. What We Know and What We Need to Know: Findings from a National Working Group

et al. 2016

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Disturbed sleep is one of the most common complaints following traumatic brain injury (TBI) and worsens morbidity and long-term sequelae. Further, sleep and TBI share neurophysiologic underpinnings with direct relevance to recovery from TBI. As such, disturbed sleep and clinical sleep disorders represent modifiable treatment targets to improve outcomes in TBI. This paper presents key findings from a national working group on sleep and TBI, with a specific focus on the testing and development of sleep-related therapeutic interventions for mild TBI (mTBI). First, mTBI and sleep physiology are briefly reviewed. Next, essential empirical and clinical questions and knowledge gaps are addressed. Finally, actionable recommendations are offered to guide active and efficient collaboration between academic, industry, and governmental stakeholders.

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Section: Hypersomnolencementioning

confidence: 99%

Sleep, Sleep Disorders, and Mild Traumatic Brain Injury. What We Know and What We Need to Know: Findings from a National Working Group

et al. 2016

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“…Recent evidence suggests an increased incidence of sleep disordered breathing (SDB) in TBI patients, with prevalence ranging from 25 [1] to 35 percent [2] compared with 4 to 9 percent in the general world population [3]. A recent investigation of sleep disorders in patients with TBI suggests as many as 50 to 70 percent of patients with TBI may suffer from some form of SDB [4].…”

Section: Prevalence Of Sleep Disordered Breathing In Tbimentioning

confidence: 99%

Sleep apnea, apolipoprotein epsilon 4 allele, and TBI: Mechanism for cognitive dysfunction and development of dementia

O’Hara¹,

Luzon²,

Hubbard³

et al. 2009

JRRD

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Abstract-Sleep apnea is prevalent among patients with traumatic brain injuries (TBIs), and initial studies suggest it is associated with cognitive impairments in these patients. Recent studies found that the apolipoprotein epsilon 4 (APOE epsilon 4) allele increases the risk for sleep disordered breathing, particularly sleep apnea. The APOE epsilon 4 allele is associated with cognitive decline and the development of dementia in the general population as well as in patients with TBI. These findings raise the question of whether patients with TBI who are APOE epsilon 4 allele carriers are more vulnerable to the negative effects of sleep apnea on their cognitive functioning. While few treatments are available for cognitive impairment, highly effective treatments are available for sleep apnea. Here we review these different lines of evidence, making a case that the interactive effects of sleep apnea and the APOE epsilon 4 allele represent an important mechanism by which patients with TBI may develop a range of cognitive and neurobehavioral impairments. Increased understanding of the relationships among sleep apnea, the APOE epsilon 4 allele, and cognition could improve our ability to ameliorate one significant source of cognitive impairment and risk for dementia associated with TBI.

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“…3,4,10,11 Furthermore, the extent of excessive sleepiness can be severe, as one study reported 53% of post acute TBI patients (mild to severe) had a mean sleep latency < 5 min on the MSLT, 8 underscoring the need for systematic studies of new and existing therapies for the management of excessive sleepiness associated with TBI. 16 In this analysis of young (mean age 31.3 years) patients with mild to moderate TBI, there appeared to be dose-dependent improvements in both sleep latency and clinical condition in patients treated with armodafinil.…”

Section: Discussionmentioning

confidence: 99%

“…4,[10][11][12][13] Despite the high prevalence of hypersomnia in the TBI population, the literature is sparse regarding treatment recommendations. Recommended strategies include addressing any underlying medical or psychiatric conditions (e.g., nasal continuous positive …”

mentioning

confidence: 99%

Armodafinil for the Treatment of Excessive Sleepiness Associated with Mild or Moderate Closed Traumatic Brain Injury: A 12-Week, Randomized, Double-Blind Study followed by a 12-Month Open-Label Extension

Menn¹,

Yang

Lankford

2014

Journal of Clinical Sleep Medicine

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Objective: To evaluate the effi cacy and tolerability of armodafi nil in patients with excessive sleepiness following mild or moderate closed traumatic brain injury (TBI). S C I E N T I F I C I N V E S T I G A T I O N SE ach year, approximately 1.7 million people in the US experience a traumatic brain injury (TBI), 1 of which 75% are classifi ed as mild in severity.2 Sleep disturbances including obstructive sleep apnea, hypersomnia, insomnia, periodic limb movement, and narcolepsy have all been reported among patients with TBI.3-5 Excessive sleepiness-or the more broad condition of hypersomnia-is particularly common among post acute TBI patients, ranging from 25% to 53% depending on the defi nitions of the condition and assessments employed.4,6-8 This is considerably greater than the rate of excessive sleepiness reported in the general population (4.0% to 20.6%). 9The appreciable effects of sleep disorders on the TBI population are not fully known, although some evidence suggests that they may contribute to cognitive impairment, mood disturbance, and disrupt recovery or rehabilitation. 4,[10][11][12][13] Despite the high prevalence of hypersomnia in the TBI population, the literature is sparse regarding treatment recommendations. Recommended strategies include addressing any underlying medical or psychiatric conditions (e.g., nasal continuous positive

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Cognitive Impairment in Patients With Traumatic Brain Injury and Obstructive Sleep Apnea

Cited by 118 publications

References 22 publications

Sleep, Sleep Disorders, and Mild Traumatic Brain Injury. What We Know and What We Need to Know: Findings from a National Working Group

Sleep, Sleep Disorders, and Mild Traumatic Brain Injury. What We Know and What We Need to Know: Findings from a National Working Group

Sleep apnea, apolipoprotein epsilon 4 allele, and TBI: Mechanism for cognitive dysfunction and development of dementia

Armodafinil for the Treatment of Excessive Sleepiness Associated with Mild or Moderate Closed Traumatic Brain Injury: A 12-Week, Randomized, Double-Blind Study followed by a 12-Month Open-Label Extension

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